Term
| what does ACE stand for in ACE inhibitors |
|
Definition
| angiotensin converting enzyme |
|
|
Term
| what do ACE inhibitors do |
|
Definition
| decrease vasoconstriction, thereby relaxing arteries and letting blood flow easier = lower blood pressure |
|
|
Term
| how do ACE inhibitors affect afterload |
|
Definition
| decrease afterload by relaxing arteries and reducing pressure |
|
|
Term
| if ACE inhibitors decrease afterload, what does that imply about the amount of blood that leaves the heart |
|
Definition
|
|
Term
| if ACE inhibitors lead to a greater amount of blood that leaves the heart, how does that affect preload/amount of blood coming into the heart |
|
Definition
|
|
Term
| what is a side effect of ACE inhibitor, decrease blood pressure |
|
Definition
|
|
Term
| what are 2 primary disease for which ACE inhibitors are prescribed |
|
Definition
|
|
Term
| why are ACE inhibitors used for patients with CHF |
|
Definition
| so the heart doesn't have to work as hard |
|
|
Term
| what are the steps of the activation of ACE? |
|
Definition
| decreased renal perfusion stimulates release of renin from arterioles of glomeruli. Renin formce ACE-I which converts to ACE-II which causes vasoconstriction |
|
|
Term
| what do ACE inhibitors do to inhibit ACE? |
|
Definition
| prevent the conversion of ACE I to ACE II |
|
|
Term
| what is the ending of drugs that are ACE inhibitors |
|
Definition
|
|
Term
| what are some examples of ace inhibitors |
|
Definition
| ramipril, captopril, enalapril, lisinopril |
|
|
Term
| where do ACE I and ACE II functions actually occur |
|
Definition
|
|
Term
| what do ACE functions affect |
|
Definition
|
|
Term
| where do ACE inhibitors react |
|
Definition
|
|
Term
|
Definition
| block cardiac specific beta receptors of sympathetic nervous system |
|
|
Term
| what is the effect of beta blockers |
|
Definition
| decrease blood pressure and heart rate. Anti-arrhythmic because irritation of nerve tissue within the cardiac muscle is decreased. |
|
|
Term
| which part of the heart muscle can depolarize |
|
Definition
| any part, but the default is the SA node |
|
|
Term
| if the SA node is not depolarizing properly, how will the heart react |
|
Definition
| other parts of the hear twill initiate depolarization, causing arrhythmias/irregular heart rhythms/irregular heart rate |
|
|
Term
| because beta blockers decrease heart rate, what precautions should be taken to exercise a patient on a beta blocker |
|
Definition
| don't increase HR more htan 20 over resting HR |
|
|
Term
| what are side effects to watch out for with patients on beta blockers |
|
Definition
|
|
Term
| what is it that beta blockers block? |
|
Definition
| sympathetic input to the heart |
|
|
Term
| what is the normal affect of sympathetic input on the heart |
|
Definition
| increased HR, contractility, and coronary artery dilation |
|
|
Term
| how do beta blockers affect arteries |
|
Definition
|
|
Term
| do beta blockers decrease resting or exercise HR |
|
Definition
|
|
Term
| how do beta blockers affect myocardial oxygen demand |
|
Definition
|
|
Term
| what is the ending of drugs that are beta blockers |
|
Definition
|
|
Term
| what are some examples of beta blockers |
|
Definition
| atenolol, metoprolol, propanolol, Carvedilol, Labetalol |
|
|
Term
| can you use the age based HR training range for a patient on a beta blocker |
|
Definition
|
|
Term
| what should be done for a patient on a beta blocker prior to exercising the patient |
|
Definition
| exercise test the patient while they are taking the beta blocker. |
|
|
Term
| what do calcium channel blockers do |
|
Definition
| block calcium ion influx, thereby inhibiting muscle contraction |
|
|
Term
| what does the lack of muscle contraction in vessels as a result of calcium channel blockers do |
|
Definition
|
|
Term
| how is oxygen demand of the heart changed with calcium channel blockers |
|
Definition
|
|
Term
| how is the coronary artery affected by calcium channel blockers |
|
Definition
|
|
Term
| how is contractility of the heart affected by calcium channel blockers |
|
Definition
|
|
Term
| how does conduction of impulses over AV node change with calcium channel blockers |
|
Definition
|
|
Term
| how is heart rate affected by calcium channel blockers and why |
|
Definition
| decreased because impulse conduction over AV node is slowed |
|
|
Term
| what are side effects of calcium channel blockers |
|
Definition
| peripheral edema, hypotension, headaches |
|
|
Term
| what are the effects of the dilation of vessels caused by calcium channel blockers |
|
Definition
| decrease blood pressure and therefore decrease the work of the heart |
|
|
Term
| how do calcium channel blockers affect the oxygen demand of the heart |
|
Definition
| decreased because the work of the heart is decreased |
|
|
Term
| do beta blockers or calcium channel blockers slow the conduction of impulses across the AV node and therefore heart rate by a greater amount |
|
Definition
| beta blockers slow heart rate more than calcium channel blockers |
|
|
Term
| why do calcium channel blockers cause peripheral edema |
|
Definition
| dilation of arteries causes graviational pooling and swelling in hands, feet, abdomen |
|
|
Term
| what are some negative effects of peripheral edema |
|
Definition
| neuropathies, clotting, emboli |
|
|
Term
| what do people on calcium channel blockers also often have to take |
|
Definition
|
|
Term
| how is bloodflow to the myocardium affected by calcium channel blockers and why |
|
Definition
| increased bloodflow to the myocardium because when the muscle relaxes, it gets better bloodflow |
|
|
Term
| how is afterload affected by calcium channel blockers |
|
Definition
|
|
Term
| how are coronary vasospasms affected by calcium channel blockers |
|
Definition
|
|
Term
| what are examples of calcium channel blockers |
|
Definition
| deltiazem, nifepdipine, verapamil, norvasc |
|
|
Term
| what is verapamil especially good at treating |
|
Definition
| controlling SVT = atrial fibrillation/flutter = arrhythmias |
|
|
Term
| what is a side effect of norvasc |
|
Definition
|
|
Term
| why will a patient's exercise performance be slowed with calcium channel blockers |
|
Definition
| decreased contractility, decreased HR, decreased cardiac output |
|
|
Term
| how do calcium channel blockers affect supraventricular arrhythmias |
|
Definition
|
|
Term
|
Definition
| alter renal function to increase secretion of electrolytes and fluid |
|
|
Term
| what is a result of loss of electrolytes |
|
Definition
|
|
Term
| how do diuretics affect the workload on the heart and why |
|
Definition
| decrease workload on heart by decreasing total work volume. Heart has to push around less total volume |
|
|
Term
| how do diuretics affect edema |
|
Definition
|
|
Term
| how do diuretics affect pulmonary congestion and why |
|
Definition
| decrease pulmonary congestion by decreasing fluid in our lungs |
|
|
Term
| how do diuretics affect intravascular volume |
|
Definition
|
|
Term
| what are side effects of diuretics |
|
Definition
| hearing problems due to ototoxicity, muscle cramps due to loss of electrolytes, urinary incontinence because they have to pee so much, dehydration |
|
|
Term
| what are the 4 types of diuretics |
|
Definition
| thiazide, loop, potassium sparing, osmotic |
|
|
Term
| what is the common, first-choice diuretic |
|
Definition
|
|
Term
| what type of diureticis hydrochlorothiazide |
|
Definition
|
|
Term
| what is the problem with loop diuretics |
|
Definition
| loop diuretics deplete electrolytes. Often need supplemental K |
|
|
Term
| what type of diuretic is laxis |
|
Definition
|
|
Term
| is lasix a weak or powerful diuretic |
|
Definition
| powerful. Good at getting fluid off quickly |
|
|
Term
|
Definition
| diuretics alter the reabsorption of sodium within the kidneys. Fluid follows the sodium and leaves the body. |
|
|
Term
| what are exercise considerations for patients on diuretics |
|
Definition
| possibility of overheating, dehydration, dysrhythmias, hypotension |
|
|
Term
| what is the problem of thiazides when given in high doses |
|
Definition
|
|
Term
|
Definition
| relax vascular smooth muscle |
|
|
Term
| what is the influence of nitrates relaxation of vascular smooth muscle? |
|
Definition
| causes coronary arteries to dilate, increasing blood flow. Also decreases afterload, thereby decreasing myocardial oxygen demand |
|
|
Term
| what is the name of the nitrate drug |
|
Definition
|
|
Term
| what are side effects of nitroglycerin |
|
Definition
| headache, hypotension, skin flushing, light-headedness, nausea and vomiting |
|
|
Term
| when do patients take nitroglycerin |
|
Definition
|
|
Term
| do coronary arteries fill in diastole or systole |
|
Definition
|
|
Term
| how does high diastolic blood pressure affect the filling of the coronary arteries |
|
Definition
| high diastolic blood pressure inhibits the filling of coronary arties because it's hard for blood to flow down the arteries when the ventricles are still tense. |
|
|
Term
| why does nitroglycerin cause headaches |
|
Definition
| vasodilation of vessels in the brain increases blood volume in the brain |
|
|
Term
| how does nitroglycerin affect blood pressure |
|
Definition
| lowers blood pressure because it dilates arteries, creating less resistance to flow |
|
|
Term
| why does skin flushing occur with NTG |
|
Definition
| tiny superficial arteries in the skin will open, bringing more blood to the surface of the skin |
|
|
Term
| why does NTG cause light headedness |
|
Definition
| initial increase in bloodflow to the brain followed by gravitational pooling in the extremities |
|
|
Term
| why does NTG cause nausea and vomiting |
|
Definition
| autonomic response caused by nitrate |
|
|
Term
|
Definition
| under the tongue; don't swallow |
|
|
Term
| what to do if a patient takes NTG |
|
Definition
| stay with her, monitor her, prop her feet up, help her to remain comfrotable |
|
|
Term
| what are venous vasodilators |
|
Definition
|
|
Term
| what are arterial vasodilators |
|
Definition
| hydralazine, calcium channel blockers |
|
|
Term
| what are combination arterial and venous vasodilators |
|
Definition
|
|
Term
| what is another term for myocardial ischemia |
|
Definition
|
|
Term
| what situation can cuase angina |
|
Definition
| increased oxygen demand or decreased oxygen supply |
|
|
Term
| what things increase oxygen demand |
|
Definition
| anything that incrases HR, contractility, myocardial well tension: exercise, heat, cold, shock, hypoxia, anxiety |
|
|
Term
| what things cause decreased oxygen supply |
|
Definition
| coronary atherosclerosis or decreased coronary artery filling from aorta |
|
|
Term
| what is coronary atherosclerosis |
|
Definition
| plaque formation in the coronary arteries. Can't increase contractility and get blood out to where it needs to go to meet demand |
|
|
Term
| what things decrease coronary artery filling from aorta? |
|
Definition
| increased diastolic blood pressure, some arrhythmias |
|
|
Term
| how does increased diastolic blood pressure decrease coronary artery filling from aorta? |
|
Definition
| coronary arteries have difficulty perfusing the heart muscle if there is already increased pressure |
|
|
Term
| how do some arrhythmias decrease coronary artery filling from the aorta |
|
Definition
| if the heart is not polarizing/depolarizing at a regular interval, its supply will not be met. |
|
|
Term
| what drugs decrease myocardial ischemia by decreasing the demand of oxygen |
|
Definition
| beta blockers, calcium channel blockers, nitrates |
|
|
Term
| if a person is taking a beta blocker, a calcium channel blocker, or a nitrate, how will their exercis capacity be affected |
|
Definition
| exercise capacity will decrease |
|
|
Term
| what drugs decrease myocardial ischemia by increasing the supply of oxygen |
|
Definition
| thrombolytics, anti-platelet agents, anticoagulants, calcium channel blockers, nitrates, oxygen |
|
|
Term
| how do nitrates increase the oxygen supply |
|
Definition
| if you have a distal muscle that needs oxygen, you can increase the vasculature going there with nitrates |
|
|
Term
| how do calcium channel blockers increase oxygen supply |
|
Definition
| calcium channel blockers cause the muscle to relax a little bit, so the demand from the muscle is not as great. The muscle uses oxygen more efficiently, taking less overall oxygen. |
|
|
Term
| what treatments are given for someone having an MI |
|
Definition
| oxygen, morphine, thrombolytics, NTG, stool softeners, aspirin, beta blockers, heparin/lovanox, ACE-inhibitors |
|
|
Term
| why is morphine given for an MI |
|
Definition
| reduce pain, help relax, reduce oxygen demand that was increased by stress |
|
|
Term
| why is aspirin given for an MI |
|
Definition
|
|
Term
| why are thrombolytics given for an MI |
|
Definition
| can have a major increase on decreasing damage both from stroke and MI |
|
|
Term
| why is nitroglycerin given for MI |
|
Definition
| causes vasodilation, particularly in coronary rteries, allowing coronary arteries to get increased blood volume to the heart muscle |
|
|
Term
| why are beta blockers given for MI |
|
Definition
| decrease blood pressure, decrease heart rate = energy conservation |
|
|
Term
| why are heparin/lovanox given for MI |
|
Definition
|
|
Term
| which blood thinner is often given prophylactically by an injection in the abdomen |
|
Definition
|
|
Term
| how is heparin administered |
|
Definition
| by iv or oral form as coumadin/warfarin. Requires monitoring |
|
|
Term
| why are ACE inhibitors used for MI |
|
Definition
| reduce vasoconstriction, lower blood pressure |
|
|
Term
| why are stool softeners given for MI |
|
Definition
| reduce side effects of other drugs. Valsalva is really bad for heart/lung patients |
|
|
Term
| what do positive ionotropes do |
|
Definition
| increase muscle contraction/heart contractility. |
|
|
Term
| what is a positive ionotrope |
|
Definition
| a medication that facilitates the heart to beat more powerfully/efficiently/stronger |
|
|
Term
| what are the 2 categories of positive ionotropes |
|
Definition
| cardiac glycosides, sympathomimetics |
|
|
Term
| what drug is a cardiac glycoside |
|
Definition
|
|
Term
| what is the main purpose of giving a patient digitalis |
|
Definition
| ift he patient has a weak heart muscle, digitalis helps it contract with greater power |
|
|
Term
| what types of patients have weak hearts |
|
Definition
| patients with heart failure, history of heart attacks |
|
|
Term
| along with increasing contractility, what is one other benefit of digitalis |
|
Definition
|
|
Term
| what do sympathomimetics do |
|
Definition
| acutely increase contractino of the heart |
|
|
Term
| what are some examples of sympathomimetics |
|
Definition
| dobutamine, levophed, isuprel, intropine |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are the benefits of digoxin/digitalis |
|
Definition
| increases heart muscle contractility, increases exercise tolerance, improves qualtify of life by allowing patients to do more |
|
|
Term
| does digitalis decrease mortality |
|
Definition
|
|
Term
| what are side effects of digitalis |
|
Definition
| dysrhythmias, nausea, vision distortion |
|
|
Term
| how are arrhythmias affected by digitalis |
|
Definition
| digitalis is a reatment for arrhythmias, but at high doses, digiatlis can cause arrhythmias |
|
|
Term
| what medications are heart failure patients on |
|
Definition
| diuretics, ACE inhibitors positive ionotropes, vasodilators, beta blockers |
|
|
Term
| why are heart failure patients on diuretics |
|
Definition
| decrease blood volume and therefore decrease blood pressure. |
|
|
Term
| why are heart failure patients on ACE inhibitors |
|
Definition
| ACE inhibitors decrease peripheral vascular resistance, thereby decreasing blood pressure |
|
|
Term
| why do we want to decrease blood pressure in a heart failure patient |
|
Definition
| decreasing blood pressure keeps the heart from having to work as hard |
|
|
Term
| why do heart failure patients take positive ionotropes like digitalis |
|
Definition
|
|
Term
|
Definition
| another name for digitalis |
|
|
Term
| what does the artery do when you decrease peripheral vascular resistance |
|
Definition
|
|
Term
| how do ACE inhibitors affect arteries |
|
Definition
| relaxes the artery, opening it up |
|
|
Term
| how do vasodilators affect arteries |
|
Definition
|
|
Term
| how do beta blockers work in heart failure patients |
|
Definition
| beta blockers ease the work of the heart by decreasing sympathetic activation, thereby decreasing heart rate and blood pressure. This is an energy conserving mechanism |
|
|
Term
| do heart failure patients take calcium channel blockers |
|
Definition
|
|
Term
| why don't you give calcium channel blockers to heart failure patients |
|
Definition
| calcium channel blockers work on the muscle. They relax the muscle by affecting the calcium exchange. We don't want to promote relaxation of the heart in someone with heart failure. We want the heart to contract harder, more efficiently to better pump blood |
|
|
Term
| how can you increase the strength of the heart in all patients including heart failure patients |
|
Definition
|
|
Term
| what is the formula for blood pressure |
|
Definition
|
|
Term
| what determines peripheral vascular resistance |
|
Definition
| atherosclerosis, blood viscosity |
|
|
Term
| what is a pathology that increases blood viscosity |
|
Definition
|
|
Term
| what are determinants of blood pressure |
|
Definition
| heart rate, stroke volume, peripheral vvascular resistance, blood volume, blood viscosity |
|
|
Term
| what kinds of drugs are anti-hypertensive |
|
Definition
| beta blockers, ACE-inhibitors, sympathetic nervous system inhibitors including beta blockers, vasodilators (Venous, arterial, both) |
|
|
Term
| what drugs are given to prevent arrhythmias |
|
Definition
| beta blockers, lidocaine, calcium channel blockers, digitalis |
|
|
Term
| how do beta blockers prevent arrhythmias |
|
Definition
| by blocking sympathetic stimulation |
|
|
Term
| what type of drug is lidocaine |
|
Definition
| refractory period altering drug |
|
|
Term
| what type of arrhythmias is lidocaine helpful for |
|
Definition
|
|
Term
| are ventricular or atrial arrhythmias more dangerous and why |
|
Definition
| ventricular arrhythmias are more dangerous because the ventricles do more important work than the atri |
|
|
Term
|
Definition
| calcium channel blocker good at treating SVTs |
|
|
Term
|
Definition
| supraventricular tachycardia = fast rate in atria such as atrial flutter/fibrillation |
|
|
Term
| what is a membrane potential altering drug |
|
Definition
|
|
Term
| what type of medicine is amiodoarone |
|
Definition
|
|
Term
|
Definition
| improves contractility and helps to control arrhythmias |
|
|
Term
| when would a patient be given amiodarone |
|
Definition
| if the patient goes into cardiac arrest and has arrhythmias |
|
|
Term
| what is a possible side effect of amiodarones |
|
Definition
| ventricular dysrhythmia, lung disease caused by fibrotic changes in the lungs |
|
|
Term
| is amiodarone effective with SVT andVT? |
|
Definition
|
|
Term
|
Definition
| very low density lipoproteins |
|
|
Term
| what are 4 types of meds for lipids management |
|
Definition
| fibric acid derivatives, fish oil, HMG-Co A Reductase Inhibitors, Nicotinic Acid |
|
|
Term
| what do fibric acid derviatives do |
|
Definition
| decrease triglycerides and VLDL |
|
|
Term
|
Definition
|
|
Term
| What do HMG-Co A Reductase Inhibitors do |
|
Definition
| decrease LDL, mild increase in HDL |
|
|
Term
| what does nicotinic acid do |
|
Definition
| decrease triglycerides and VLDL |
|
|
Term
| what type of drug is niacin |
|
Definition
|
|
Term
| what type of drug is lipitor |
|
Definition
| statin = HMG-Co A Reductase Inhibitor |
|
|
Term
| what are some anti-coagulants |
|
Definition
| lovanox, coumadin, warfarin, heparin, aspirin, plavix, pradaxa |
|
|
Term
|
Definition
| injected in abdomen prophylactically |
|
|
Term
| how is coumadin/warfarin gien |
|
Definition
|
|
Term
| what must be done with coumadin |
|
Definition
|
|
Term
| how is heparin administered |
|
Definition
|
|
Term
| how is aspirin administered |
|
Definition
|
|
Term
|
Definition
| discourages platelet aggregation |
|
|
Term
|
Definition
|
|
Term
|
Definition
| less monitoring and dietary restrictions |
|
|
Term
| what is atrial fibrillation and why is it bad |
|
Definition
| muscle twitches/vibrates without fully contracting. Affects the output of the atria. Causes increased risk of clot in atria because the atria chamber doesn't efficiently contract to clean out all the blood into the next chamber. Therefore, some of the blood hangs out and clots. This clot could dislodge and go where we don't want it. |
|
|
Term
|
Definition
| like a defibrillator for the atria |
|
|
